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The baby can be breech or head down throughout the pregnancy and it’s of no real concern until 34 weeks gestation. At that point, the baby’s head is big enough and firm enough that it can be palpated and a reasonably good assessment can be made by a clinician. This is also the point in the pregnancy where it makes sense to take steps to encourage the breech baby (3% of all pregnancies) to turn to head down through Webster technique (chiropractic), knee/chest position, or external cephalic version by an obstetrician.

For birth workers, these are some of the things I’ve observed about pregnant women carrying the baby in a breech position. They are not 100% diagnostic but can alert you to look closer for breech position. If the only thing that is concerning in the final weeks of pregnancy is “What position is this baby in?”, it’s possible to have a “one swipe” ultrasound. An ultrasound technician can do a very brief scan and see where the baby’s spine, head and bum are. There’s no need to do a time consuming (prolonged ultrasound exposure) scan just for position. If the baby is breech, you’ll want to know where the placenta is located as well. If the baby is head down, the scan can stop and the parents can go celebrate.

These are some signs that the baby could be breech at 34 weeks and beyond:

1 heart tones heard with fetoscope (not doppler) in upper segment (belly button level or higher).
2. Woman has feeling of a hard ball in her ribcage. Woman tends to squirm and press down on the top of her uterus when sitting.
3 head is slightly firmer than the bum on palpation after 35 weeks gestation age.
4. Abdomen has a more tight/taut sausage shape/quality than the usual round/squishy orange shape/quality.
5. Where are the baby hiccups felt? If high (woman’s belly button region), breech is suspected.
6. If the woman has had a previous breech birth, check carefully because a fibroid or a bicornate uterus (or other unusual anatomy) may predispose to carrying all her babies breech. (One woman I have worked with had 7 breech births. She had 2 uterii.)

I must admit that the best breech births that I have attended are the ones that were NOT diagnosed in advance. Women who have a surprise breech are spared all the worry, over-testing, over-lecturing and general misery that diagnosis of breech can bring.

Please let me know in the comments if you have any other tips or techniques for spotting those little beings who want to back into life. Thanks Gloria

I wanted to share this memory with you, Ted. I don’t know if you remember this incident but I’ve told it to so many people and it always makes me laugh so I thought you might enjoy this trip down memory lane.

Many years ago, when we both had young kids and you were married to Karen, I bumped into you in the parking lot of the “7-11” on West Fourth Ave. We exchanged small talk for a while and, all of a sudden, you got a strange look on your face and blurted out the following, unforgettable (to me) sentence: “Gloria, is it true you were a topless dancer in China?” I couldn’t fathom how that thought could ever enter someone’s head. I’ve been accused of many things in my life but that was pretty far-fetched—I had never been to the Orient, I had never been to the local nude beach, none of what you said made any sense at all. But, somewhere in there, I started thinking “How could this husband of another birth attendant have gotten this idea in his head?”

Then, I remembered a birth that I had called Karen out to one evening. It was the second vaginal birth for the woman. When Karen arrived at the home, I went through the woman’s chart with her. The only surgery the birthing woman had ever had was a breast augmentation. She was a Caucasian woman who was married to a Japanese man. I explained to Karen that the couple had met in Japan and the first child had been born in a Japanese hospital, completely natural birth. The woman had been in Japan because she had taken a job as a hostess in a nightclub in Japan.

Now, they were living in Vancouver and having their second child. The baby was born just after midnight and I sent Karen home soon after.

I’m guessing that what happened is that she crawled into bed with you, Ted, and you must have asked her “how did the birth go?” There wasn’t much to tell except that bit about her previous breast augmentation surgery so perhaps Karen told you about that. Somehow, in your sleepy state, that got changed into “Gloria Lemay was a topless dancer in China”.

Once I had retraced the strange pathway of that statement, I said to you: “You know, Ted, that’s not true about me BUT it’s way more interesting than my real life. Will you, please, spread that rumour about me!”

Thanks for the special moments and laughs that knowing you has added to my life. I love you and your dear family.

THE death of a baby last week in Montreal has reignited the debate over one of the most emotional social policy issues in the province – midwifery.
Isabelle Brabant, a self-trained midwife who has delivered more than 400 babies, arrived at a hospital less than 10 minutes after the baby stopped breathing during a home birth and her resuscitation efforts failed. Doctors were also unsuccessful in reviving the infant.
Dr. Augustin Roy, president of the Quebec Corporation of Physicians, wasted no time condemning the tragic events, saying “home birth is a quasi-criminal act for a woman who has had a cesarean in the past.”
In the past, proponents of midwifery have shrugged off such attacks, saying doctors are more interested in maintaining the status quo (including revenues from hospital births) than in improving the quality of treatment.
Yesterday, however, they decided to draw a line in the sand.
“We’ve tolerated this witch hunt for long enough,” said Marie-Claude Desjardins, president of Naissance-Renaissance. “We demand that obstetrical violence end. . . . We demand that respect of women begin.”
Michele Champagne, president of the Quebec Alliance of Practicing Midwives, said: “Midwives are not endangering the lives of women and children any more than doctors are, and to suggest otherwise is a lie.”
Statistics compiled by the Office of the Coroner show there are about 350 deaths a year of children in their first week of life. One a day.
In the past five years, six of those deaths have been after midwife- assisted births. One a year.
There were about 97,000 births in Quebec last year, slightly more than 1,000 of them midwife-assisted.
Yet, midwifery remains in a strange sort of legal limbo. Last year, the government announced, as part of its massive health-reform package, plans for pilot projects that would lead to the licensing of midwives and their practicing in hospitals alongside doctors.
But the plan is stalled by the insistence of doctors’ groups that “self-trained” midwives be ruled inadmissible.
Because midwifery is not formally recognized in the law, there are no standards, but the Association of Practicing Midwives insists on all its members having a minimum of three years of training, and that at least two qualified midwives assist in home births. But, as the law stands, midwives are banned from doing their work in hospitals.
Polls in the province show 80 per cent of voters in favour of legalized midwifery, and legalization of the practice in Ontario has turned up the heat to the point where Quebec Health Minister Marc-Yvan Cote warned doctors that if they continue with their obstructionist tactics, he will skip pilot projects and go directly to legalization.
Three years ago, Ms. Brabant was attending another birth where the baby died. The subsequent coroner’s inquest, which many feared would be the death knell of the movement, exonerated her, and support for the cause has grown tremendously.
This time the Office of the Coroner has decided an inquest is not even warranted. That fact, coupled with the reaction of Dr. Roy, has convinced midwifery proponents that victory is near.
Micheline St-Onge, a parent whose child died during birth at a hospital, drove the point home, by bringing the debate back to its roots.
“We have to do everything to ensure the comfort of women and the safety of their children, so ultimately they must be allowed to make the choice between having their baby delivered by a doctor or a midwife,” she said yesterday.
“Very few people know just how painful it can be to lose a child,” Mrs. St-Onge said. “Why have things degenerated to the point where we have lost sight of that, where the death of our children is used merely to score” debate points.
“No child’s life should be cheapened to that point.”

Please let me know well in advance if you are unable to find any item on the list. Collect all supplies and place them into a box. Place the box in an easily accessible place. Please tell the midwives where the supplies are kept when they arrive for the birth.

Preparing Your Home:
Make up 5 casserole dishes to get you through the first days after birth and freeze them. Put a plastic sheet on your bed in the last week of pregnancy in case your waters break. Dust and clean the bedroom. Clean the toilet and bathtub. Clear off the top of a chest of drawers or other surface for us to put our instruments on. Make arrangements to have your pets out of the house during the birth.

Put clean linens in HOT dryer for one half hour. During the last 10 minutes throw in 3 brown paper grocery bags and heat them through. When dryer finishes, fold the hot linens with clean hands and put them in hot bags. Seal them with staples or tape and label the outside. Store in a dry place. You do not need to use your best linens…clean is our main concern.

Mix all ingredients together- use warm water to help dissolve the honey and calcium, and then chill. You can also make ice cubes. Buy enough ingredients to make 4 quarts. This is a delicious drink for after the birth as well. *After the baby is born you can add 1/4 tsp. cream of tartar to this drink to assist with peeing after the birth.

This is an online conversation that I had with a grand multip (woman who has given birth more than 5 times). There are special things about birth after the fifth baby. . . for instance, sometimes the process can be stop and start for days and, then, suddenly. . . here’s the baby. There is nothing wrong with that way of birthing but, because large families are relatively rare, many practitioners lose faith and patience and brand the woman as “failure to progress”.

Another unique thing about women carrying a fifth or more baby is that they are prone to what midwives call the “blue right leg syndrome”. It can be alarming to see how blue the right leg becomes in pregnancy but, then, the baby is out and the woman’s right leg looks just fine again. I like to read things by the midwives in the USA who serve religious groups with big families. Lots of little anecdotes like that.
CORRESPONDENCE BETWEEN GLORIA AND CAROLINE
Hi Gloria,
I am wondering if you could answer a couple things for me.
I was reading your post about the 30 Minute Third Stage, and saw your comment about the anti-bleed tea. I’m curious to know more about this.
I understood that shepherd’s purse was not to be used until after the placenta was delivered, and that it was dangerous to use it before.
I see that one of the ingredients for your anti-bleed tea is shepherd’s purse. Can you share with me how it differs in the tea, as opposed to using the tincture? Also, is this safe to use as a grand multip? This is my 10th baby, 14th pregnancy.
I tend to bleed a fair bit with my births, and I am trying to be prepared this time, (due in August) and read and research things that I could/should try to have on hand, especially in case my attendant doesn’t make it here on time. I tend to go quickly, and feel a strong need to be prepared this time.
Thank you for any input you are willing to share (smile emoticon). Caroline

TUES 22:35
Hi Caroline, One of the things with grand multips that really helps prevent bleeding is going for a 1/2 hour brisk walk. One of my clients found some research on it and it really seems to work. I don’t know why. As far as the shepherd’s purse, no one can really do studies on these herbs and their use after a birth. We worry more about after pains with grand multips. Therefore we give a cramp bark /cinnamon tea. A couple of things that I’ve seen lately that interest me for the after pains are 1. Increasing magnesium supplementation after the birth. 2. Emptying the bladder more often than you think you need to. Just get up and pee if it’s been a while and don’t wait till you feel like pee’ing. Apparently these 2 things are very helpful for cramps. Thank you for writing. I’d love you to have a smooth, relaxed birth. Gloria
06:07

Thank you so very much for your time!!
These are some very interesting points.

I’m curious for a little more information on the brisk walk. Is this something your recommend in labor? Or for the days leading up to birth?

I feel so much peace about our upcoming birth. Much more so than I’ve felt with any of the others. But I also am loving to learn as much as I can about birth as a whole, and things that could be useful for my own as well.
Thank you again. Caroline

10:30
You’re very welcome, Caroline. I mean a walking program starting NOW. I never ask women to walk when they are in the birth process. I’m afraid they will hit me! ha ha. You’ll know what you want to do when having the baby, it’s the preparation that’s important. By a walk I mean a brisk walk with no kids, no purse, flat shoes and really walking as fast as you can. Gloria

Gloria, Thank you! I will start doing that today. ?

I am soaking up as much information as I can.

I also have to say that I love following your page and reading on your site. So much information that has been so useful.
Thank you for everything you do!!
Makes me wish I was in Canada and could meet you! Caroline

That’s very sweet of you. You are exactly the woman I am writing for, so many people just can’t “get” what I’m trying to communicate.Gloria

I am loving the learning! I have been trying to dig as deep as I can, and find as many different ideas and perspectives as I can. I’m always thrilled when I find new perspective that makes sense!
Will you be offering your online class again in the future? I would be very interested in taking part, if you do.Caroline

Added: Another tip I will give to grand multips. When you have lots of older children, they ALL want to hold the new baby. This gets to be a competition and a struggle and it could be a reason why the mother might bleed too much. Explain to the entire family like this: “It’s very important that Mommy has the baby on her skin for the first day of the baby’s life. That helps Mommy’s body to change over from being pregnant to being a nursing mother. If we want Mommy to stay at home and be healthy, we are ALL going to wait until the baby is 24 hours old before we take turns holding the baby.” In most families, the kids really understand this and they don’t mind so much not holding the baby as long as no one else is either.

Gallery

I don’t know who these photos belong to or any details of the birth. I love the way she throws her head back when the head is crowning. That coaching we see so often to “tuck the chin down to … Continue reading →

Someone asked me recently what things are done differently with vaginal births after cesarean (VBAC) as opposed to a first baby. Midwives usually reply to this question with a reassuring, “Oh, we treat you normally,” but there are differences in the two situations that can be distinguished in midwifery practice.

Prenatal Preparation

The full history of the events leading to the cesarean is very important. With a VBAC client, ask her to get her operative record, nurse’s notes, anesthetist’s report, pediatric report—get all the records and go over them thoroughly. Often the couple did not get full or accurate information about what was going on. Sometimes there’s a little “clue” as to what went wrong that could help to prevent a cesarean from recurring. Sometimes there is a big chunk of information that didn’t get communicated. I saw one set of records where the only indication for the cesarean was the note from the obstetrician that “this woman is a natural childbirth fanatic.” Another set of cesarean records had no indicator whatsoever of why the woman received abdominal surgery when she had given birth at l9 years old. When she told her parents that the midwife was perplexed and could see no reason for the surgery, her father admitted to her that he had stayed in the visitor’s lounge all day and had been verbally threatening to the doctor: “If anything happens to my daughter, I’ll sue you!” This helped the daughter to understand what had happened to her and also helped her to be firm with her father that he was to be nowhere near her VBAC birth.

With VBAC births it is important for the midwife to work with the dad prenatally. A VBAC father is in a horrible position because, despite the fact that his wife had an operation and a long recovery, he still got a live wife and baby at the end of it all. VBAC dads are often “fantasy bonded” to the medical system and terrified of childbirth in general.

The good thing is that they listen very carefully and really know when the care is better and more thorough and when the practitioner is authentically on their team. I find that if the midwife talks to them very honestly, they can trust and be fully supportive when the birth time arrives.

If the woman has dilated past five centimeters in the first birth, I plan for it to be fairly fast—like any second baby. If the woman has not gone into the birth process or not dilated past five the first time, that’s all right, she’ll still give birth vaginally, but we have extra midwives on call to bring fresh energy if the others get discouraged or tired. We plan for it to be like going to two births in a row. The point that the woman reached in her first birth is often a psychological hurdle for her. If she dilated to six centimeters the first time, the news that she is seven or eight will be a relief and a breakthrough. One of our clients, a minister’s wife, said over and over again in her pregnancy: “I just want to feel what pushing is. If I only get to push, I’ll be happy. I just want to know what other women mean when they say they had to push.” She’d had a Bandl’s ring in the first birth process and the cesarean was done at five centimeters. We were praying that the complication wouldn’t repeat. She dilated smoothly and began to push. With each push she would exclaim “Thank you Jesus, thank you Jesus!” What a wonder it was to watch her push out the baby, a girl whom she named Faith.

All humans have a certain propensity to self-sabotage, and the VBAC woman must be on guard against her own defeating patterns. The midwife must be bold in pointing out ways that the woman is repeating dumb moves—there’s no place for us being “nice” if it will mean another cesarean. An example of this: If the woman had a cesarean with five support people, she will be cautioned to keep her VBAC private.
Privacy and quiet are a must, and we will be very forceful about setting up logistics before the birth so that the woman can birth in peace. In short, the VBAC is high priority because this woman’s whole obstetrical future rides on its success.

Keeping a VBAC normal

We show the couple lots of videos of beautiful VBAC births because one video is worth a thousand words. If you don’t have your own, purchase a copy of my dvd “Birth with Gloria Lemay” which shows a beautiful VBAC waterbirth. Art therapy is helpful in creating the environment before the birth day. I place a big sheet of drawing paper in front of the father and mother with lots of colored pencils and instruct them to, “Draw your birth cave” or, “Color your birth.” When they are finished, I write the date on the two drawings and put them away in my files. After the birth, we take them out and are amazed at the details that were drawn weeks before and later manifested in the actual birth.

I schedule longer appointments with VBAC women because they seem to need to obsess. I don’t have solutions to many of their fears but it seems to help to just be able to talk to someone who cares and understands. I usually also ask them to, “Tell me how you know that this time you’re going to have a vaginal birth?” The answers always amaze me. One woman said, “Because this time I’m not depending on my doctor or my midwives—me and my husband are going to have this baby.” I suggested that she give up depending on her husband, too. She looked terrified at that idea but I could see that she understood; she looked me in the eye and said, “Right!” That was the moment I knew she would do it. She’s had three water homebirth VBACs since then, and after each birth her first words were, “I did it.”

VBAC women are so grateful for the opportunity to birth normally that they are often shy to ask for the extra things that make a birth beautiful, such as a Blessingway ceremony or a waterbirth. The midwife must remember to offer and encourage the mother to think “really beautiful birth” rather than “bare minimum birth.” I find it helpful to ask, “This is the only second baby you will ever have—what would make it really special?”

The Day of the Birth

In my practice, no one gets induced in any way or gets pain medication. This policy is very important for all women but especially for VBAC women. If there is a small chance of uterine rupture, we must have everything on our side to prevent it (the rate of VBAC uterine rupture without induction is 0.4 percent or less than one in 200*). It is beyond my comprehension how anyone could give a VBAC woman misoprostol (Cytotec), oxytocin or castor oil or strip the membranes or use any other form of induction when that would triple her chance of having a uterine rupture.

I believe that VBAC women have longer, gentler births because Nature is compensating for the scar. There is no hurrying. I would be terrified to induce a VBAC woman but feel safe to attend her at home if her body is pacing itself naturally. We keep it in the back of our heads that the signs of rupture are stabbing pain, unusual bleeding, decels of the baby’s heart, or a peculiar shape of the abdomen but we don’t look for problems if they don’t exist.

We are especially careful with the birth of the placenta in a VBAC because there is a slightly increased chance that the placenta might be adhered to the scar, and we do not want to have a uterine prolapse caused by pulling.

Postpartum Differences

After the birth, VBAC women need to be told that they can walk upright. They can’t believe that they can straighten at the waist right after giving birth. Then, they can’t believe it when we ask them to do sit-ups and leg raises on day one. Usually by day three when we go to visit, their husbands say, “Oh, she’s gone to the gym.” With VBAC women, the complaints are very few in the postpartum period because they are comparing to post-surgery pain and any minor scrapes and bruises seem like nothing.

In the years following the birth, these women and men send us more clients than anyone else, and if we’re in legal trouble, they’ll be at all the rallies, raise money, stamp the envelopes, write letters to legislators, and be our true friends for life. A VBAC is an amazing experience for the birth attendants as well as the family. Very Beautiful And Courageous (VBAC).

Q & A: VBAC

Two Types of Pelvises
by Gloria Lemay

Q: From a midwife: A great many Asian women are very small and small-footed, yet I hear that many of them birth vaginally. Would you comment on pelvic size?

A: When I get a VBAC client and she is endlessly self-psychoanalyzing and beating herself up for having a c-section, I usually say, “Look you made two big mistakes! First you were born in the wrong country, and second you were born in the wrong century—if you’d been born and raised l00 years ago in France, for instance, you would have given birth vaginally.” When I teach my workshops, I tell the students there are two types of pelvises in allopathic medicine: l) contracted, and 2) adequate. In midwifery, there are two types of pelvises as well: l) roomy, ample, and 2) you could get a pony through there!

Gloria Lemay is a Private Birth Attendant in Vancouver, British Columbia, Canada and a frequent contributor to Midwifery Today and The Birthkit.

“I think it’s a good and empowering thing for a woman to check her own cervix for dilation. This is not rocket science, and you hardly need a medical degree or years of training to do it. Your vagina is a lot like your nose- other people may do harm if they put fingers or instruments up there but you have a greater sensitivity and will not do yourself any harm. Clean your hands well and make sure your fingernails are trimmed and rounded.

“The best way to do it when hugely pregnant is to sit on the toilet with one foot on the floor and one up on the seat of the toilet (or if that yoga is too difficult, put one foot up on the bathtub or a stool with your knee bent).

Put two fingers in and go back towards your bum. The cervix in a pregnant woman feels like your lips puckered up into a kiss. On a non-pregnant woman it feels like the end of your nose. When it is dilating, one finger slips into the middle of the cervix easily (just like you could slide your finger into your mouth easily if you are puckered up for a kiss). As the dilation progresses the inside of that hole becomes more like a taught elastic band and by 5 cms dilated (5 fingerwidths) it is a perfect rubbery circle like one of those Mason jar rings that you use for canning, and about that thick.

“What’s in the centre of that opening space is the membranes (bag of waters) that are covering the baby’s head and feel like a latex balloon filled with water. If you push on them a bit you’ll feel the baby’s head like a hard ball (as in baseball). If the waters have released you’ll feel the babe’s head directly.

“It is time for women to take back ownership of their bodies.”
-Gloria Lemay, Vancouver, BC

One birthing woman who checked her own cervix described it like this: “I could feel my bag of water bulging down and then later the baby’s head once the waters broke- so cool.”
“How did I do it? I just reached up in all the way to the back and felt. It’s sort of awkward/difficult to reach but if you are familiar with what your cervix normally feels like, sort of like the tip of your nose, it gets shorter and stretchy. I felt it at like maybe 2 cm, about 6, which is when I could feel the bag, and then when it was time for baby to come. When the contractions were getting super intense I pushed a bit and that was enough to break my waters. Babe came shortly after.”
(shared with permission) 2014